Board of Trustees and Officers

SIXTEENTH ANNUAL REPORT

Toledo StateHospital

Governor of the State of Ohio,

FOR THE

Fiscal Year Ending November 15, 1899.

BOARD OF TRUSTEES:

Charles Foster- Fostoria.

D. L. Cockley - Shelby.

G. P. Campbell, M. D , - Wauseon.

L. C.cole - Bowling Green.

D. N. Powell -Ottawa.

OFFICERS.

H. A. Tobey, M. D. - Superintendent.

A. F. Shepherd, M. D. - Assistant Physician.

W. G. Cooper, M. D .

G. R. Love, M. D

R. B. Leister, M. D

F.J. HAAG,M. D

C. S. Miller , Steward.

E. M. Garrett,Storekeeper.

Mrs. M. C. Tobey , Matron.

REPORT OF TRUSTEES.

Hon. Asa S. Bushnell, Governor:

The prevailing conditions at this institution the past year have been very gratifying, and further illustrates the superiority of modern methods. As we progress, each year finds additions in the line of non-. restraint, whereby the comfort and happiness of our unfortunate inmates is enhanced. The superintendent in his report has given in detail an account of the improvements made during the past year, and has also given in detail the reasons for the estimated appropriations for the next two years.

Now, that the centennial of the birth of the State is to be celebrated at Toledo, in a way commensurate with the dignity of the State, it must be apparent that it is quite important that the State Hospital at Toledo should be put into the most presentable condition possible. It is quite certain that a hospital for the insane that can secure the following words of commendation from so eminent a specialist as John McDougall chairman of the Asylums Committee, of London, England, will be an object of special interest to thousands of the visitors to the centennial. Speaking of the State Hospital at Toledo, Mr. McDougall says : " Certainly the administration is most successful. The patients appear to be very happy and contented, more so than any I have ever seen."

If the appropriations asked for can be granted, our period of construction will have passed, and the appropriations for the future will be small, the addition of a cottage now and then to provide for the increase of insane people of our district, is about all that will be required for construction purposes. When the appropriations asked shall have been expended, the per capita cost per inmate cared for will be about $650. It is probable that economy of construction, with the gratifying results obtained, has not been equaled by any other institution of its kind anywhere to be found. In view of the conditions that are to prevail at Toledo in 1902, we cannot too urgently seek to secure the full appropriations submitted.

The Board is under renewed obligations to the superintendent, his corps of able assistants, the matron, the steward and storekeeper, and all employees generally.

Respectfully submitted,

Charles Foster, President,
D. L. Cockley, Vice President,
G. P. Campbell, M. D.,
L. C.^ Cole,
D. N. Powell.

SUPERINTENDENT'S REPORT.

To the Honorable Board of Trustees of the Toledo State Hospital:

Gentlemen : The 15th of November dates the close of another fiscal year in the history of the institution under your control, and it again becomes my duty, as well as my pleasure, to present for your consideration another annual report, this being the sixteenth since the institution was founded, and the twelfth since it wa3 in operation.

The following table shows the movement of the population for the year :

TABLE I.

table

By reference to the above table it will be seen that there were remaining in the institution at the end of last year 1,385 patients, of which number 715 were men and 670 were women. There were admitted during the year 251 men, 183 women, of both 434, making the total number under treatment 1,819, of which 966 were men, 853 were women. 59 men and 45 women, 104 in all, were discharged " Recovered." 6 men and 16 women, 22, were discharged " Unimproved," and 7 men and 8 women were discharged "Unchanged." 3 men were found not to be insane. 67 men and 44 women, 111, died, and one man was transferred to theDayton State Hospital, making the total number removed from the institution 321, of whom 183 were men and 138 women, leaving in the institution at the date of this report 783 men and 715 women, a total of 1,498 patients. The average number resident during the year was 723 men, Q68 women, a total of 1,391, which is one less than the average number resident the preceding year, notwithstanding the institution at the end of this year had 113 more patients than at the end of last. The lower average number resident for the year just passed, as compared with the number remaining at the close of the year, is due to two causes. First, for the greater portion of the year from one to three cottages were almost continually vacant for repairs, and to the farther fact that a new hospital for men, which accommodates 80 patients, was completed and occupied in September.

The percentage of recoveries, based on the number admitted during the year was for men 25.50, for women 24.59, for both 23.96. The ratio of deaths for the total number under treatment was for men 6.94 and for women 5.16, for both 6.10.

The per capita cost, including current expenses and officers' salaries was §124.80, and including receipts from all sources it was &138.50. The increase of $4.15 in the per capita cost of this year over last year, is due in part to the fact that a number of cottages were vacated for repairs, and therefore the institution could not care for its full complement of patients and in part to increase in prices in many of the com modifies of liviug; and too, a considerable amount has been paid from the current expense fund for certain kinds of labor that would ordinarily have been paid from the ordinary repair fund, because, of the appropriation for ordinary repairs being barely sufficient.

Notwithstanding the*death rate is somewhat higher this year than last, yet the general health of the household has been good. There have been but few cases of acute sickness and no disease contagious or epidemic in character, except a number of cases of erysipelas from which two patients died, both of whom were very aged and infirm. Ten. more persons died of paretic dementia, seven more of terminal dementia and six more of epilepsy than died from the same causes last year, which is sufficient to account for the difference in the death rate of the two years. Two suicides have occurred and one death was hastened, if not caused, by an injury. As the patient did not talk or make any complaint the injury was not discovered until his death. It was found that three of the lower ribs were broken on the right side near the spine. A coroner's inquest was held, but the investigation did not elicit when or how the injury was received. The case was one of resistive melancholia in an elderly man. He had to be bathed one or twice every day and resisted with all his force. It took two or three attendants to bathe him and it was supposed that he must have fallen across the edge of the bath tub in his struggles, although this fact was not clearly brought out. One of the suicides occurred by a patient secreting a knife, with which he cut his throat. The other was caused by an old gentleman tying his suspenders about his neck and putting his cane through and twisting them until death was caused by strangulation. Accidents of this nature are always distressing, yet with so large a number of insane persons under treatment, it is only reasonable to expect that they will now and then occur, despite the most careful precautions.

With the exception of the instances just mentioned, nothing has occurred of an unfortunate nature. The affairs of the institution have gone along pleasantly and smoothly without strife or contention, and a general feeling of kindliness and friendliness of one toward another has very markedly prevailed. In the comparatively few instances where it has been necessary to remove persons from their positions, their offenses have been due more often to lack of judgment than deliberate intention to do wrong. Each year it has been the tendency of the administration to become more and more liberal in the government of the institution; to do away more and more with set rules and regulations, and to place people more upon their honor, and trust their self-respect and good judgment to restrain them from wrong-doing, rather than any arbitrary rule of"Shant" or "Shall."

The medical care of the patients has been competent, careful and painstaking and very thing at our command has been done for them that might add to their well-being. Special effort has been put forth to provide suitable employment and entertainment, believing that in these two lines lie the most important factors in treatment. As often as twice a week throughout the entire year the patients have been assembled for amusements. During the summer season the hospital brass band, under the directorship of Mr. H. C. Walls, my secretary and stenographer, have given very delightful open air concerts -every Tuesday evening, and almost every Friday evening throughout the entire year the hospital orchestra, led by Mr. W. C. King, has furnished music for the dances. In addition to these regular evenings the musicians of both organizations have joined in giving special concerts. At each of these concerts musicians with more than local reputation favored us with their talent. Mrs. Albro Blodgett and Hon. J. P. Byers sang for us at one of them, Miss Hubbard sang at another, at another Mr. W. E. Van Doren played a cornet solo and Mr. P. E. Uhl played a solo on the saxophone, at another the Philharmonic Trio, consisting of Professor Steinhauser, violinist, Professor Speil, cellist, and Professor Kortheuer, pianist, favored us with several numbers, and the Ionian Quartet sang some pleasing songs. Besides these concerts, a musical treat was given us by the Euridice Club, under the directorship of Mrs. S. M. Jones. We have had numerous other entertainments, consisting of minstrel shows, dramatic performances, slight of hand, stereopticon shows with lectures, and moving picture exhibitions. The holidays have been made a special feature of entertainment, they being of all the days in the year the most lonesome and sad for the patients. This year, as in preceding years, a large number of patients attended the Tri-State Fair, and more than half the patients in the institution took a day's outing at the Casino. The wagonette was kept going all summer and fall in taking patients out riding. On two occasions quite a large number of the lady patients spent the entire day out nutting. On none of these occasions has anyone escaped, or made an attempt to.

The improvements made during the year have been numerous, varied, and some of them, rather extensive; the most important of which was the completing and furnishing of a new hospital building for men. Work on this building was begun a year ago last summer, but a delay of several weeks was occasioned by the failure of the contractor to get the iron beams used in its construction, consequently the building was not enclosed until well into mid-winter. The building was completed about the middle of August, and by the first week of September we began occupying it. It has ample accommodations for 80 patients, and is divided into three distinct wards, two on the upper floor and one on the lower. A portion of the building is three stories high, the third story being used for sleeping rooms for attendants. It is provided with two dining rooms, one on each floor. Each dining room has a large serving room in connection with it. The serving rooms are equipped with steam tables, coffee and tea urns, ice boxes, cupboards, etc., and one of them is provided with a cook stove, so that meals or special dishes may be prepared for sick patients at any time. The building is constructed of common red brick, laid in red mortar and trimmed with terra-cotta. It is very artistic in design and is by far the handsomest building of the institution. There was but $27,000 appropriated for this building, which was insufficient to build it as designed, therefore a wing which would have provided 16 single rooms, and been connected to the main building by a short corridor, was not built. This wing would have had a stairway and an outside entrance and could have been shut off from the main building by doors, and either floor used for the isolation of cases afflicted with infectious or contagious diseases. Every year we have quite a large number of cases of erysipelas, and, notwithstanding, we take every precaution in the way of disinfecting the rooms and sterilizing the beds and clothing, for want of proper facilities for isolation we cannot wholly control its spreading. So far, however, we have been fortunate in never having had any diseases that were distinctly contagious in character, break out in the institution. We cannot tell when this may occur, therefore there should be provisions made where such cases could be cared for without endangering the institution to a general epidemic. Aside from this argument for this wing more single rooms are almost indispensable for the proper classification and treatment of the patients occupying the building. Bids received for the construction of this wing at the time the contract for the hospital was let, showed that it could have been built for about $6,500. With the increased price of material and labor it would probably cost at this time $8,000, and I recommend that an appropriation for this amount be requested. The three cottages that were in process of reconstruction at the date of the last annual report, have been completed and another cottage was completely overhauled during the summer and fall, making six buildings, excepting the walls and roofs, that have been practically rebuilt during the last two years. By additions to four of them room for 35 more patients have been provided. There are six cottages remaining that are practically in their original condition and must be overhauled within the near future, if they continue to be occupied. Additions would be built to them making increased accommodations for 30 patients over their present capacity. Another cottage, to which an addition was built three years ago, must have new ceilings throughout the old portion of it and a new floor for the second story. The two buildings for infirm patients, each having two wards and each ward accommodating 40 patients, are in very bad condition. The plumbing must be renewed, the heating apparatus improved, all the ceilings replastered, and better provision made for ventilation. The building that is used as a hospital for women, and the corresponding one that was used for a like purpose for men, are, if anything, in worse condition than the buildings for infirm patients. A careful estimate shows that it will cost from twenty-eight to thirty thousand dollars to remodel, build additions, and practically renew the interiors of these 11 buildings. A hospital building for women, corresponding to the one just completed for men, is an urgent necessity. The present building used for the purpose, although it were put in proper repair, is entirely inadequate. It accommodates but 40 patients, crowded to its fullest capacity, with but little means for separation or classification of the persons occupying it. Old and young, acute and chronic, demented and intelligent, if they are sick or invalid, are collected in this building, which is a great injustice to the more recent and curable class of patients. In an institution of this character it is not only necessary that those who are sick and in ill health physically should have hospital care, but it is quite as important that a large per cent, of recent cases should be placed where they may be carefully observed and have special care and treatment in order that all may be done that should be for their restoration. There should be at least three wards or departments; one for those who are sick, one for the more acute and disturbed class, and another for those who are convalescing. A duplicate of the hospital building erected for men, with a wing for contagious diseases added, should be built for women, which; with the additions to be built to the cottages that must be repaired, would give the institution a capacity for 1,600 patients without overcrowding. At the date of this report there were 1,498 patients in the institution and there were 226 insane persons in the county infirmaries of the district, as reported by the secretary of the Board of State Charities. There were on the same date in the institution 164 patients from the three counties, Ashland, Lorain and Wayne, belonging to the district of the Massillon State Hospital. With the patients from the county infirmaries transferred and the hospital building in question completed and occupied, the institution would be filled to within 38 of its capacity, making no allowance for any increase in the number of the insane in the district during the time of the completion of the Massillon State Hospital and the erection of a hospital building here. Such a building as has been described would accommodate 100 patients, arid could be built and furnished for $50,000. Considering the imperative need of this improvement, and in view of the provision passed by the last General Assembly, making it compulsory for the State hospitals to take the insane from the infirmaries by the first of June next year, I most earnestly recommend that you urge upon the Legislature the importance of making the necessary appropriation. At the time of making our annual report two years ago the boiler plant seemed in fairly good condition and there was no thought but what it would meet the requirements of the institution for several years to come, as the boiler had been thoroughly repaired and the' walls and setting had been renewed only three years before. The heavy firing of last winter, however, due to the prolonged cold weather, almost completely wrecked the plant. Numerous defects developed in the boilers, the brick walls crumbled, and the boiler fronts were pushed out and broken. It was with difficulty and no small element of danger that we were able to carry them through the winter. The question arose as to whether it would be better to repair the old boilers and reset them, or put in a new plant. A representative of the Hartford Steam Boiler Insurance and Inspection Company was called and after a thorough investigation made a written report to the effect that the condition of the boilerswas such that we would not be justified in going to the expense of repairing and resetting them and that an entirely new plant was necessary.